The Moment of Diagnosis: Maintaining the Integrity of the “I”

David Tresemer, PhD

A person sits across from you—you as a licensed professional or life coach or mentor or elder or friend—and asks in words or in a tone of voice, “What’s wrong with me?” A list of symptoms pours out, intermixing with this question. Then comes a very important event: the moment of diagnosis. You name a construct. You gather all the symptoms together in a bundle and give that bundle a label.

The word diagnosis comes from “gnosis”—knowing—and “dia”—parting a vague lump into two, the essential and the non-essential, discerning what is the truth at the core and separating that from what isn’t true. A diagnosis can guide you in how you will help to make the symptoms go away, which is why the client is there, right? Not necessarily. We have to look closely at that moment of diagnosis.

The cascade of reported symptoms can include many levels of experience. They can be physical—“My heart aches, and I feel shortness of breath.” They can be behavioral—“I don’t like to go outside the way I used to.” They can be emotional—“I really don’t like the way he smirks when I make a mistake.” They can include patterns of action, thinking, or feeling. When asked further, the client can add more and more reports of what’s wrong, though sometimes the words are inadequate—“I just don’t feel like myself.” Then you must watch for how the body moves and listen for the tone of the voice.

The spoken reports are like a gaggle of geese honking and moving this way and that without a leader. Nearly always, the flushing out of symptoms is accompanied by anxiety. The practitioner often gets the sense of being the last resort, that many other activities have been tried, and now the client is desperate. The pressure is on to do something about this clamor.

Not only the one who suffers is applying the pressure. Lurking in the background can often be medical insurance programs, reporting requirements of a government agency, prejudice against admitting weaknesses as in the military, or concerns about what the permanent medical records will say. For example, mental health and substance abuse programs often require a dual diagnosis, also called co-morbidity or co-occurring disorder. Most common is the combination of a substance abuse disorder and a generalized anxiety disorder or any of a number of so-called disorders. Some programs require the naming of two supposed psychological disorders. To help the client into a program, a practitioner can feel pressed to tick two boxes.

The Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association is now in its 5th Text-Revision form (DSM-5-TR). At over 1100 pages, it is the most comprehensive view of what can go wrong, mostly emotionally and behaviorally, but also pressing into the physical side of human experience. The DSM codes coordinate with the ICD-10-CM (International Classification of Diseases, 10th revision, Clinical Modification) of the World Health Organization, whose 72,748 codes (a number that grows annually) give names and descriptions to many human experiences of “what’s wrong with me.” As the ICD has now moved to version 11, there will be pressure to update the DSM as well.

The DSM system gives you numbers that you can tick off on an evaluation form, the most common being F41.1, which used to be 300.02 (and for some agencies still is), often abbreviated GAD, which clinicians know means Generalized Anxiety Disorder—easy to tick that box as it describes nearly every client sitting with you. You can also tick off F41.9 (which for many diagnostic tick-the-boxes forms is still 300.00). In some agencies, this is a kind of catch-all because it means Unspecified Anxiety Disorder; in other words, you don’t know where the trauma came from, but it’s there in front of you in your client. Ideally, a diagnosis of unspecified is temporary, as you seek more information about the client, but it indicates that you’re dealing with something that you agree is severe.

I recently heard one of the main editors of the DSM speak, describing with pride the hundreds of highly-experienced people who have worked together in various committees to create the categories and codes of the DSM, a mighty accomplishment of cooperation. He explained how wonderful it is to have codes that can be attached to people’s situations so that they may be treated more effectively. He emphasized that the DSM does not move past diagnosis into treatment modalities, recognizing that many treatments are available for any particular diagnosis.

But that’s not exactly true. When you perceive the world in a certain way, it directs your actions. For example, the rise in the diagnosis of trauma has changed how we view human experience. One can welcome the change of diagnosis of shell shock—for soldiers after World War I, with the primary treatment mode of telling individuals to “just get over it”—to PTSD (post-traumatic stress disorder), which recognizes the impact on body and mind of nearby explosions and shocks as acts of aggression meant to kill you. However, experiences that were once thought to be learning experiences are now seen as emotionally scarring and named trauma or PTSD. Experiences that were once considered character-building now qualify individuals for medications.

Other diagnostic systems are used around the fringes of mainstream psychology and medicine. Someone versed in the four humors, as revitalized in anthroposophy, would ask, “Do I see before me someone who is more sanguine or more melancholic?” An astrologer might ask, “What the client is saying—is that an indication of a Mercury challenged by Mars either in the birth chart or by transiting planets [planets moving through the sky strumming the strings of patterns set at birth]?” (I admit to being partial to the combination of mythic and specific in intelligent astrology.) A pulse diagnosis might reveal the energy meridian that can respond to dry needling. There are many other systems to narrow one’s focus.

A diagnosis can direct your attention to a specific system under stress within the construct that you find most helpful.

Here is the key to diagnosis. What is the sensation that you experience when you find a label that fits the symptoms? You examine all the criteria, and you say, “Aha, F60.0, that’s it!—the client shows four (of the seven) indicators of Paranoid Personality Disorder.” What happens at that moment?

To answer that question, it will help to explain one of the twelve senses recognized by anthroposophy for the human being. (A full description of all twelve can be found in The 12 Senses course through—we here emphasize one of them.) One of the senses in the development of humanity is the Sense of the ‘I’ of the Other. When you behold another human being as the bearer of individuality, a soul-in-training, confronted and occasionally overwhelmed by life’s dramas—as the vehicle for an “I am” incarnated to this earth in order to mature—then you realize that any troublesome symptoms may express the tribulations of that journey, rather than diversions from it. The sufferings aren’t wrong, per se, though they may be very challenging. When you feel the “I” of another, you open more deeply to your own “I”—your spirit flame.

When you behold the human being before you as an object that needs to have a diagnostic number attached, that human being becomes an “It.” As a consequence, you become more of an “It,” too.

The moment of diagnosis can lock in an “It-It” relationship. It can also lead to an “I-I” relationship, where the diagnosis narrows the field of all possibilities to something more specific yet remain open to metamorphosis and change. You become less the mechanic and more the helper who can assist the client in seeing further down the road of their maturing process. When a client says, “I just don’t feel like myself,” that may not help you to find a DSM code, yet you can translate that statement into, “My personality does not experience the embrace and guidance of my ‘I.’” Such a statement may guide you to help them find their “I.”

You may have to use DSM or ICD codes to connect the client with the way the world functions. Yet the moment of diagnosis can, with effort, be kept open and living rather than deadening.

Watch your moments of diagnosis, with clients, with people you pass on the street, in a million different situations, to assess tendencies toward the “It” or to the “I” of each. It makes all the difference in the world.


Bio: David Tresemer, PhD, has taught in the certificate program in Anthroposophic Psychology (, and presently, at the StarHouse in Boulder (, with courses on New Astrology, the 12 Senses, and other online courses.